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FOR CIT USE ONLY <br /> 0 City of Orono Date Received: �(1' Permit# <br /> O <br /> P.O.Box 66 <br /> 2750 Kelley Parkway EJIn-House SAC Determination Form Completed <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Approved By(If Required): 1. <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) <br /> (ALL PERMITS- May be subject to further review and may not be issued when the application is received) <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> Check All That Apply) <br /> ®Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> .,New Connection ❑Additional Connection 8 Re-Connection ®Repairs ❑Disconnect <br /> Job'Site/Owner Information: <br /> Site Address: 0 y- C�/l�a�.✓ �-A- <br /> Owner: <br /> vOwner: I-I/K (<,,,. 5- Mailing Address: <br /> City: O2c—o _ Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information <br /> Contractor: %dam cam,- cif=war= Contact Person: ��s l//�✓%f� '�'� < <br /> Address: �r�ir State License#: <br /> City: ��«��„�r,� Zip: -Tr. -:' xpiration Date: <br /> Phone: Alternate Phone: G/�Tf6bG <br />